Sacramento Medi-Cal Managed Care Advisory Committee

Transcription

1 Meeting Minutes August 24, 2015, 3:00 PM 5:00 PM DHHS Administration 7001A East Parkway Sacramento, CA Conference Room 1 Sacramento Medi-Cal Managed Care Advisory Committee COMMITTEE MEMBERS x DHHS, Primary Health Sandy Damiano, PhD Chair x Hospital Tory Starr x Advocate Todd Higgins x Hospital Rosemary Younts x Advocate Jenni Gomez x Beneficiary J.R. Caldwell, Sr. x Clinic J. Miguel Suarez, MD x IPA Sean Atha Clinic Jonathan Porteus, PhD IPA Anna Berens - excused x DHA Mary Behnoud Pharmacy Frank Cable x DHHS Sherri Heller, EdD Physician Marvin Kamras, MD x DHHS, Behavioral Health Uma Zykofsky x Physician Nathan Allen, MD DHHS, Social Services Debbi Thomson Health Plan Jane Tunay (interim) EX-OFFICIO MEMBERS Health Plan Steve Soto County Board of Supervisors Ted Wolter x Health Plan Janet Paine (interim) x County Board of Supervisors Lisa Nava x Hospital Ellen Brown (filling in for both Kaiser seats) x State DHCS Kasey Baker x Hospital Laura Niznik Williams x Health Care Options Lili Zahedani Page 1 of 6

2 Committee in Attendance: 18 Public in Attendance: 27 Topic Welcome, Introductions and Opening Remarks Sandy Damiano, PhD, Chair Homeless Services Innovations Jenny Ismert (United Healthcare) Minutes Sandy Damiano, PhD, welcomed the committee, panel members, and members of the public, facilitated introductions, and reviewed the agenda and packet. Sandy Damiano provided the following updates: Enrollment Data: As of August 1, 2015, total enrollment is 408,757, with a take-up of 6,610 and default rate 33%. Health plan distribution provided on the on the Enrollment Data. See Medi-Cal Managed Care Enrollment Data - available on website Sujatha Branch is stepping down from the committee and was unable to attend today s meeting. Todd Higgins from Disability Rights is in attendance and will join the committee representing advocates. Welcome Todd! Today s agenda is packed. Key areas include Homeless Services Innovations (United Healthcare), Telehealth (Dignity Health and UCD), DHCS Updates and Complex Care Management. All materials are posted to the Committee webpage. Jenny Ismert, Vice President of Housing for United Healthcare Community and State presented. See website for the Housing & Healthcare PowerPoint. Key points: At this stage of ACA and Medicaid expansion, seeing recalibration of the system for chronically homeless, complex patients that typically were not covered under Medicaid. Noticing the link between healthcare and housing as well as this population s utilization patterns across multiple health and social service support agencies. Stabilizing housing can greatly impact how services are accessed. In June 2015, CMS released guidance about housing related services. Link: Committee Questions/Comments Rosemary Younts Commented that Dignity s pilot, Housing First, in partnership with a community agency, is showing amazing results. She asked what the CMS guidance looks like. Jenny CMS guidance deals with the non-discretionary process. There are opportunities to advance policy discussion, and under the waivers, there are Page 2 of 6

3 Homeless Services Innovations Jenny Ismert (United Healthcare) Telehealth Jim Roxburgh Dignity Health Jana Katz-Bell UC Davis opportunities to request reimbursement for intensive case management, rent assistance, housing location services, etc. Sean Atha Does United do the entire housing program (development, build-out, purchasing) themselves or do they have community partners? Jenny United works with community based partners, sophisticated housing developers, FQHCs, etc. to think creatively about connecting housing and healthcare. Sean Atha Can you expand on engagement of the homeless population? Jenny We have learned that just offering housing as an option is not enough to get them engaged. We recognize the sensitivity and skills it takes to really get them engaged and that there is a continuum of approaches to leverage existing community based providers and get better connected with them and the members. Dr. Allen Has there been intervention for providing members with transportation on a regular basis? Jenny We look at the entire spectrum of social determinants of health which includes transportation outside of nonemergency medical transportation. Tory Starr Asked the other health plans if any of them have been looking into issues around housing and creating supportive structures? Ellen Wellspace T3 program is similar to Dignity s. Also looking at investment strategy. Jenny added that United s investments are primarily through low income tax credit opportunities. Health Net is putting together a resource guide for Medi-Cal service counties with information to link homeless members with resources in their community. The guide will be distributed to providers, IPA s and Health Net member services. Anthem s case management process looks at the full range of member needs. Sherri Heller What is connection to homelessness on slide 8? Jenny These are members United is unable to locate (UTL). They reviewed data using assumption that UTL are likely housing insecure. They backed into utilization spending for the top 30 UTL individuals. Sandy Damiano Reminder - next month there will be a committee discussion about access. Access paths and supports are critical for the homeless. Discussion will be about what we are doing and what we can do to support beneficiaries including special populations that have more needs. Jim Roxburgh, Director Dignity Health Telemedicine Network (DHTN), presented. See website for the Dignity Health Telehealth PowerPoint. Jana Katz-Bell, Assistant Dean, Interprofessional Programs, UC Davis, presented. See website for the UC Davis Telemedicine PowerPoint. The slides contain a great deal of information and graphics. Key Points: Jim Roxburgh - Highlighted an outpatient program using DHTN for the past 9 months and reduced the readmission rate from 19% to 5%. Page 3 of 6

4 Telehealth Jim Roxburgh, Dignity Health Jana Katz-Bell UC Davis State DHCS Update Kasey Baker Jana Katz-Bell - Noted that Dignity s stroke program is recognized around the world. Standards about access are very clear and can only be provided via telestroke. Neurology residents must be trained in telestroke to graduate. This is only field with that requirement. (Note: UCD is known throughout the state for their Pediatric Telehealth.) Committee Questions/Comments Sean Atha Are there opportunities for community providers to partner with and access telehealth resources in their own facilities? Jana Katz-Bell Sierra Health Foundation had a conference on telehealth last month. The Telehealth Resource Center for the nation is in Sacramento. These are good resources for how to get started, how to access ideas for funding equipment, and how to access care. Jim Roxburgh Dignity s Telehealth process is to: 1) determine need, 2) what service will meet that need, 3) define workflows, 4) layer on technology. Janet Paine Anthem has been doing telemedicine since 1999 and partnering with UC Davis and community clinics. Challenges include reimbursement, high no show rate in Medi-Cal population, and managing completion of entire visit. There were incentives to integrate EHR but there is a lack of state and federal resources to implement telemedicine which involves significant workflow changes. Jim Roxburgh The next level of telemedicine will involve the PA s/np s/nurses. DHTN is working on program with speech therapists from the stroke program. Uma Zykofsky How does it get documented? Who is the primary documenter? Jana Katz-Bell For UC Davis, both organizations provide documentation. Tory Starr Commented that the word transformation which was used is Jana s presentation is an excellent way to think about telemedicine. Right now medicine is provided at the convenience of the providers with telemedicine it will be provided at the convenience of the members. Some commented that technology is ahead of the policy issues. Sandy Damiano noted that Anna Berens was unable to attend this meeting but she provided two handouts on econsult and she is happy to talk about it at the next meeting if there are any questions. The handouts are posted. Kasey Baker provided an update. GMC Request for Application (RFA): GMC RFA release date is still pending. September Meeting - Kasey will bring DHCS colleague(s) to the next meeting to provide an overview of the 1115 Waiver and Behavioral Health Treatment (BHT) Transition of BHT (Medi-Cal) Service from the Regional Centers to Managed Care Health Plans. If there are questions on these topics please send them to Page 4 of 6

5 Sandy Damiano in advance. She will forward them to Kasey. Complex Care Management Programs Health Plans Committee Questions/Comments: Rosemary How will the BHT transition work? Kasey There have been stakeholder meetings. The transition is scheduled for February DHCS will send day notification letters to members. More information will be available at the next meeting. Jane Tunay (Health Net) Health Net has three departments to assist members with complex issues/needs. 1) Member Services accessed via internet member portal or telephone, helps with benefits, appointments, access, 24/7 nurse advice. 2) Public Programs Department coordinators assist with access to care and continuity of care issues. Coordinators work with the member until the issue is resolved. 3) Healthcare Services Department offers a) ambulatory case management basic care coordination, b) complex case management members at high risk for hospitalization and poor outcomes, and c) disease management members with chronic medical conditions. All case management is telephonic, but may include a home visit, and is provided at no additional cost to members. Members can self-refer by calling member services and referrals can be made by providers, family members, hospital discharge planning staff, and community members. Health Net Medi-Cal member services: Committee Questions/Comments: Dr. Allen For members with overlap with IPA s who do they call? Jane IPA s also have case management program. Health Net sent out provider a update in August and providers can complete a case management referral form and submit it to Health Net. For members with issues there are many avenues for assistance including grievances, patient advocate, health plans, health care options, etc. Janet Paine (Anthem Blue Cross) Anthem offers the same services as Health Net with regard to member services. They have a strong healthcare management services team specifically focused to Northern California area. The team is made up of nurses, health educators, and behavioral health specialists who coordinate care, provide case management, conduct twice a week rounds for members admitted to hospital, review pharmacy data regularly, etc. Safe choices program looks at high utilizers of narcotics. Also have a readmission initiative to work closely with members who are discharged from hospital getting them into case management and working with the primary care provider and specialist to eliminate issues and barriers and partner with IPAs and PMGs to comanage members. Page 5 of 6

6 Complex Care Management Programs Health Plans Public Comment Closing Remarks and Adjourn Committee Discussion: Sean Atha River City also does complex care management in coordination with health plans. Sandy Damiano Earlier Tory Starr asked about the role between plan and IPA when you have a client who needs complex care management. Sean Atha Responded that first and foremost it is the responsibility of the health plan but the medical group delegated a full range of services for the member. The medical group is accountable for providing the services and the health plan is responsible for oversight to ensure the medical group provides the services. Dr. Miguel Suarez HALO is working with the purveyor of the patient registry to provide a lot of these services. Patient registry went live two weeks ago. They are analyzing the data to develop strategies to increase case management and care coordination. They are also working with health plans to create aggregate data to implement strategies to improve case coordination. More to come. Julie Beyers, staff, Medi-Cal Dental Advisory Committee Upcoming meeting this Thursday. DHCS who attends quarterly will be there. Also representatives from the Little Hoover Commission will attend. The Commission has been requested to look into Denti-Cal, and they will be sharing their plans and how stakeholders can assist or provide information. Also, First 5 Sacramento s Executive Director, Toni Moore, is retiring in October. Julie Gallelo, First 5 Yolo, will take over as Executive Director for First 5 Sacramento. There will be a hello/goodbye open house on Friday, Sept 25, 2016, from 2:00 p.m. to 4:00 p.m. Sandy Damiano thanked everyone for attending and participating in today s meeting. September Meeting - There will be no special presentations at the next meeting. The committee will spend the time discussing access issues (primary, specialty), what we can do to work together for our beneficiaries and recommendations on access. Please come prepared for those discussions. It may be helpful to review past meeting minutes and blasts (which have articles and data) for previous discussions this committee have had regarding access. With no additional business to discuss, the meeting adjourned. Next Meeting Monday, September 28, 2015 / 3:00 5:00 PM / DHHS Admin Building / 7001A East Parkway, Conf. Rm. 1 Page 6 of 6